Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska

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Resources and References Resources ATS, CDC, IDSA. “Diagnostic Standards and Classification of Tuberculosis in Adults and Children” (Am J Respir Crit Care Med 2000;161[4 Pt 1]). Available at: http://www.cdc.gov/tb/publications/PDF/1376.pdf CDC. Self-Study Modules 1 – 5 on Tuberculosis (Division of Tuberculosis Elimination Web site; 2008) and CDC. Self-Study Modules 6 – 9 on Tuberculosis (Division of Tuberculosis Elimination Web site; 2000). Available at: http://www.cdc.gov/tb/education/ssmodules/default.htm CDC. Core Curriculum on Tuberculosis (2011) (Division of Tuberculosis Elimination Web site; updated October 2011). Available at: http://www.cdc.gov/tb/education/corecurr/default.htm Tenover, R., et al. “The Resurgence of Tuberculosis: Is Your Laboratory Ready?” (Journal of Clinical Microbiology 1993:767–770). References 1 ATS, CDC, IDSA. Controlling tuberculosis in the United States: recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America. MMWR 2005;54(No. RR-12):15. 2 ATS, CDC, IDSA. Controlling tuberculosis in the United States: recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America. MMWR 2005;54(No. RR-12):32. 3 ATS, CDC, IDSA. Controlling tuberculosis in the United States: recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America. MMWR 2005;54(No. RR-12):32. 4 ATS, CDC, IDSA. Controlling tuberculosis in the United States: recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America. MMWR 2005;54(No. RR-12):15. 5 ATS, CDC, IDSA. Controlling tuberculosis in the United States: recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America. MMWR 2005;54(No. RR-12):15–16. 6 ATS, CDC, IDSA. Controlling tuberculosis in the United States: recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America. MMWR 2005;54(No. RR-12):32. 7 CDC. Classification system. In: Chapter 2: transmission and pathogenesis. Core Curriculum on Tuberculosis (2011) [Division of Tuberculosis Elimination Web site]. Updated 2011. Available at: http://www.cdc.gov/tb/education/corecurr/pdf/chapter2.pdf. Accessed June 20, 2012. 8 CDC. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005. MMWR 2005;54(No. RR-17):4–5; CDC. Targeted tuberculin testing and treatment of latent tuberculosis infection. MMWR 2000;49(No. RR-6):7–9, 22. 9 CDC. Targeted tuberculin testing and treatment of latent tuberculosis infection. MMWR 2000;49(No. RR-6):8–9. 10 ATS, CDC, IDSA. Controlling tuberculosis in the United States: recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America. MMWR 2005;54(No. RR-12):32. 11 ATS, CDC, IDSA. Controlling tuberculosis in the United States: recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America. MMWR 2005;54(No. RR-12):32. 12 ATS, CDC, IDSA. Controlling tuberculosis in the United States: recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America. MMWR 2005;54(No. RR-12):34. 13 ATS, CDC, IDSA. Controlling tuberculosis in the United States: recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America. MMWR 2005;54(No. RR-12):33. 14 ATS, CDC, IDSA. Controlling tuberculosis in the United States: recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America., MMWR 2005;54(No. RR-12):33; CDC. Medical evaluation. In: Chapter 4: diagnosis of TB. Core Curriculum on Tuberculosis (2011) [Division of Tuberculosis Elimination Web site]. Updated 2011. Available at: http://www.cdc.gov/tb/education/corecurr/pdf/chapter4.pdf. Accessed June 20, 2012. A L A S K A T U B E R C U L O S I S P R O G R A M M A N U A L Diagnosis of Tuber culosis Disease 5.19 R e v i s e d N o v e m b e r 2 0 1 2
Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005. MMWR 2005;54(No. RR-17):11; ATS, CDC, IDSA. Diagnostic standards and classification of tuberculosis in adults and children. Am J Respir Crit Care Med. 2000;161:1378; CDC. Module 3: diagnosis of tuberculosis infection and disease. Self-Study Modules on Tuberculosis [Division of Tuberculosis Elimination Web site]. 2008. Available at: http://www.cdc.gov/tb/education/ssmodules/pdfs/Module3.pdf Accessed November 16, 2010. 15 ATS, CDC, IDSA. Controlling tuberculosis in the United States: recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America. MMWR 2005;54(No. RR-12):33. 16 ATS, CDC, IDSA. Controlling tuberculosis in the United States: recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America. MMWR 2005;54(No. RR-12):33. 17 CDC. Classification system. In: Chapter 4: diagnosis of TB. Core Curriculum on Tuberculosis (2004) [Division of Tuberculosis Elimination Web site]. Updated October 2004. Available at: http://www.cdc.gov/tb/webcourses/CoreCurr/index.htm . Accessed November 16, 2010. 18 CDC. Classification system. In: Chapter 4: diagnosis of TB. Core Curriculum on Tuberculosis (2011) [Division of Tuberculosis Elimination Web site]. Updated 2011. Available at: http://www.cdc.gov/tb/education/corecurr/pdf/chapter4.pdf. Accessed June 20, 2012. 19 ATS, CDC, IDSA. Controlling tuberculosis in the United States: recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America., MMWR 2005;54(No. RR-12):33; CDC. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005. MMWR 2005;54(No. RR- 17):11; ATS, CDC, IDSA. Diagnostic standards and classification of tuberculosis in adults and children. Am J Respir Crit Care Med. 2000;161:1378; Medical evaluation. In: Chapter 4: diagnosis of TB. Core Curriculum on Tuberculosis (2011) [Division of Tuberculosis Elimination Web site]. Updated 2011. Available at: http://www.cdc.gov/tb/education/corecurr/pdf/chapter4.pdf.Accessed June 20, 2012. 20 CDC. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005. MMWR 2005;54(No. RR-17):11; and ATS, CDC, IDSA. Diagnostic standards and classification of tuberculosis in adults and children. Am J Respir Crit Care Med. 2000;161:1378. 21 CDC. Module 3: targeted testing and the diagnosis of latent tuberculosis infection and tuberculosis disease. Self-Study Modules on Tuberculosis [Division of Tuberculosis Elimination Web site]. 2008. Available at: Available at: http://www.cdc.gov/tb/education/ssmodules/pdfs/Module3.pdf. Accessed November 16, 2010; and CDC. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005. MMWR 2005;54(No. RR- 17):11. 22 ATS, CDC, IDSA. Controlling tuberculosis in the United States: recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America. MMWR 2005;54(No. RR-12):33. 23 CDC. Diagnostic microbiology. In: Chapter 4: diagnosis of TB. Core Curriculum on Tuberculosis (2011) [Division of Tuberculosis Elimination Web site]. Updated 2011. Available at: http://www.cdc.gov/tb/education/corecurr/pdf/chapter4.pdf. Accessed June 20, 2012. 24 ATS, CDC, IDSA. Controlling tuberculosis in the United States: recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America. MMWR 2005;54(No. RR-12):33. 25 ATS, CDC, IDSA. Controlling tuberculosis in the United States: recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America. MMWR 2005;54(No. RR-12):33. 26 Washington State Public Laboratory Tuberculosis Unit. Internal untitled report on the review, analysis, and recommendations on the Gen-Probe Amplified Mycobacterium Tuberculosis Direct Test (MTD). January 2004. The report includes the following references: (1) Gen-Probe Incorporated. Amplified Mycobacterium Tuberculosis Direct Test Package Insert. Gen-Probe Incorporated, San Diego, CA, 2001; (2) ATS, CDC, IDSA. Diagnostic Standards and Classification of tuberculosis in Adults and Children. American Thoracic Society, 1999; (3) Piersimoni, C. and Scarparo, C. Relevance of commercial amplification methods for direct detection of Mycobacterium tuberculosis Complex in clinical samples. Journal of Clin. Micro., December, 2003: 5355-5365; (4) Centers for Disease Control and Prevention. Update: Nucleic acid amplification tests for tuberculosis. MMWR, 2000; 49:593-594; (5) Schluger, N.W. Changing approaches to the diagnosis of tuberculosis. Am. J. of Resp. Crit. Care Med., 2001; 164:2020; (6) Catanzaro et al. The role of Clinical suspicion in evaluation as a new diagnostic test for active tuberculosis. JAMA, Feb. 2, 2000; Vol. 283 No. 5 P.639. 27 Daley CL, Gotway MB, Jasmer RM. Radiographic manifestations of tuberculosis: a primer for clinicians, second edition. San Francisco, CA: Francis J. Curry National Tuberculosis Center; 2006:1–30. 28 CDC. “The medical history.” In: Module 3: targeted testing and the diagnosis of latent tuberculosis infection and tuberculosis disease Self-Study Modules on Tuberculosis [Division of Tuberculosis Elimination Web site]. 2008. Available at: http://www.cdc.gov/tb/education/ssmodules/pdfs/Module3.pdf. . Accessed November 16, 2010. 29 CDC. Medical evaluation. : Chapter 4: diagnosis of TB. Core Curriculum on Tuberculosis (2011) [Division of Tuberculosis Elimination Web site]. Updated 2011. Available at: http://www.cdc.gov/tb/education/corecurr/pdf/chapter4.pdf. Accessed June 20, 2012; and CDC. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005. MMWR 2005;54(No. RR- 17):11. 30 ATS, CDC, IDSA. Diagnostic standards and classification of tuberculosis in adults and children. Am J Respir Crit Care Med 2000; 161:1378; CDC. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care A L A S K A T U B E R C U L O S I S P R O G R A M M A N U A L Diagnosis of Tuber culosis Disease 5.20 R e v i s e d N o v e m b e r 2 0 1 2
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Alaska Tuberculosis Program Manual
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Purpose............................
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Monthly assessment of adherence ...
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When to Expand a Contact Investigat
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Introduction CONTENTS About the Ala
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How to Use This Manual Portable Doc
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Printing To access the print dialog
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Abbreviations Refer to the list bel
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QFT QuantiFERON ® -TB test QFT-G Q
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Alaska Statutes and Regulations on
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National and State Program Objectiv
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Indicator 3 Thorough contact invest
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National Standards and Recommendati
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Roles and Responsibilities Contact
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Local Public Health Agencies Table
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Resources and References Resources
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Introduction Purpose Use this secti
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Contact investigation: Collecting,
Page 37 and 38: Reporting Tuberculosis Detecting an
Page 39 and 40: Prompt reporting (prior to culture
Page 41 and 42: Use the Infectious Disease Report F
Page 43 and 44: Data Collection Forms The following
Page 45 and 46: Genotyping Genotyping is a useful t
Page 47 and 48: References 1 ATS, CDC, IDSA. Contro
Page 49 and 50: Introduction Purpose Use this secti
Page 51 and 52: child or a person acting on behalf
Page 53 and 54: When to Conduct Targeted Testing Al
Page 55 and 56: Alaska Program Standards for Health
Page 57 and 58: B Notifications CONTENTS Introducti
Page 59 and 60: Table 1: NUMBERS OF FOREIGN-BORN PE
Page 61 and 62: chest radiograph and if sputum AFB
Page 63 and 64: Follow-up of B1 and B2 Tuberculosis
Page 65 and 66: Evaluation of B1, B2, and B Tubercu
Page 67 and 68: Treatment Prescribe medications as
Page 69 and 70: 12 Centers for Disease Control and
Page 71 and 72: Introduction Purpose Use this secti
Page 73 and 74: Tuberculosis Classification System
Page 75 and 76: Table 2: PERSONS AT HIGH RISK FOR T
Page 77 and 78: Table 3: WHEN TO SUSPECT PULMONARY
Page 79 and 80: Diagnosis of Tuberculosis Disease T
Page 81 and 82: 1. Exposure to Infectious TB: Ask p
Page 83 and 84: Physical Examination A physical exa
Page 85 and 86: For more information on chest radio
Page 87: Laboratories should report positive
Page 91 and 92: 50 CDC. National plan for reliable
Page 93 and 94: Introduction Purpose The overall go
Page 95 and 96: Basic Treatment Principles Follow t
Page 97 and 98: Treatment Regimens and Dosages Use
Page 99 and 100: Table 3: FOUR TREATMENT REGIMENS FO
Page 101 and 102: † 4 Table 4: DOSES*OF FIRST-LINE
Page 103 and 104: Figure 1:TREATMENT ALGORITHM FOR DR
Page 105 and 106: a. In remote locations in Alaska, m
Page 107 and 108: Antituberculosis Drug Rifampin (RIF
Page 109 and 110: Antituberculosis Drug Rifapentine (
Page 111 and 112: Reporting Reactions The table below
Page 113 and 114: Response to Treatment For consultat
Page 115 and 116: Figure 2: MANAGEMENT OF TREATMENT I
Page 117 and 118: Post-Treatment Evaluation Routine f
Page 119 and 120: Treatment in Special Situations Tre
Page 121 and 122: Resources For consultation regardin
Page 123 and 124: with an increase in overall complet
Page 125 and 126: Liver Disease Management of TB in p
Page 127 and 128: After the initial phase (first two
Page 129 and 130: Extrapulmonary Tuberculosis The bas
Page 131 and 132: Resources and References Resources
Page 133 and 134: Diagnosis of Latent Tuberculosis In
Page 135 and 136: Forms All required and recommended
Page 137 and 138: High-Risk Groups Certain factors id
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Diagnosis of Latent Tuberculosis In
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continually exposed to populations
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Administration of the Tuberculin Sk
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See “Two-Step Tuberculin Skin Tes
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See “Live-Virus Vaccines” under
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For more information on IGRAs and t
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Table 5: TARGETED TESTING FOR LATEN
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Treatment of Latent Tuberculosis In
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Policy Detailed information on the
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Window period prophylaxis is treatm
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Regimens Identify an appropriate re
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Dosages Once the appropriate regime
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Side Effects and Adverse Reactions
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If a patient reports to a healthcar
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Antituberculosis Drug Rifampin (RIF
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DOT is strongly encouraged for thos
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Table 7 describes the duration of t
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Alcoholism Alcohol-Related Treatmen
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Medication Administration and Pharm
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National Tuberculosis Controllers A
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24 CDC . “Recommendations for Use
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Diagnosis and Treatment of Latent T
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All children suspected or diagnosed
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Latent Tuberculosis Infection (LTBI
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History of BCG vaccination is not a
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Because of their higher specificity
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Table 3: COUNTRIES AND AREAS WITH A
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Treatment of Latent TB Infection (L
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For consultation regarding the trea
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Monitoring DOT is mandatory for INH
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For young infants, some experts rec
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TABLE 8: SIGNS AND SYMPTOMS OF PULM
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Treatment of Tuberculosis Basic pri
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Regime n 1 2 3 ❺ Table 10: FOUR T
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† 35 Table 11: DOSES*OF FIRST-LIN
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Monitoring Response to Treatment Ch
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Child Care and Schools: Children wi
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Other TB medications are not commer
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10 Centers for Disease Control and
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Case Management CONTENTS Introducti
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patient-centered approach to case m
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Alaska TB Program: Timeline for the
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For assistance with language issues
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Ascertain the extent of TB illness
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medical/health problem. The date of
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necessary to teach people how to ta
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Treatment Plan Components Recommend
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Implementation Activities To begin
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o Indicate the number of doses prov
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Review the status of the contact in
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For more information, see the “Di
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importance of continued treatment a
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5. Review information with the prov
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Completion of Therapy The case mana
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Case Closures Other than Completion
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Conduct a case management meeting o
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Biweekly (BIW) doses of TB medicati
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Use DOT with other measures such as
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It is important not to send a mixed
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Medical Orders Progressive Interven
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CDC. Module 9: “Patient Adherence
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36 New Jersey Medical School Nation
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75 CDC. Module 9: patient adherence
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Introduction Purpose A contact inve
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For roles and responsibilities, ref
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Decision to Initiate a Contact Inve
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chest radiographic findings that ar
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In general, a contact investigation
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Time Frames for Contact Investigati
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Circumstances unique to Alaska may
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Circumstances unique to Alaska may
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Activity Purpose Maximum Time Inter
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Infectious Period Determine the inf
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In general, for the purposes of con
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General Guidelines for Interviewing
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Healthcare workers should remember
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Index Patient with Positive Acid-Fa
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Index Patient with Negative Acid-Fa
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Contact Evaluation, Treatment, and
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Definition of abbreviations: HIV =
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Note: An IGRA may be used in place
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When to Expand a Contact Investigat
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Figure 7: EVALUATION, TREATMENT, AN
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CDC’s “Framework of Program Eva
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Definitions of abbreviations: AIDS
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elease assay; LTBI = latent tubercu
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officials to distinguish between di
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References 1 ATS, CDC, IDSA. Contro
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44 CDC, NTCA. Guidelines for the in
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Available Laboratory Tests Table 2:
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Table 3: PCR Testing Algorithm and
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Table 4: SPECIMEN COLLECTION METHOD
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5. If possible, send the specimen o
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Specimen Shipment There are three m
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Patient Education CONTENTS Introduc
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treatment, common side-effects of m
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Education Topics During the initial
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10. Explain the signs and symptoms
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Patient Education Materials Get th
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References 1 CDC. Module 4: treatme
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National Guidelines The following g
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Transfer Notifications CONTENTS Int
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For roles and responsibilities, ref
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Follow-Up Type When to Initiate Not
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Action Transfers Within Alaska Tran
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Provide the patient with a. A copy
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References 1 CDC. International not
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Infection Control CONTENTS Introduc
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of TB infection control principles
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Administrative Activities 13 Key ac
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Personal Respiratory Protection Alt
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For regulations in your area, refer
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Employee Health All employees, phys
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Figure 1: TWO STEP TESTING AND FOLL
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Isolation To reduce disease transmi
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Table 4: CRITERIA FOR PATIENTS TO B
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When to Initiate Airborne Infection
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Confirmed Tuberculosis Disease A pa
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Multidrug-Resistant Tuberculosis Di
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Environmental Controls in the Patie
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Return to Work, School, or Other So
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Tuberculosis Infection Control in P
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Transportation Vehicles To prevent
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7 CDC. Guidelines for preventing th
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Forms: Alaska State Public Health L
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ALASKA STATE PUBLIC HEALTH LABORATO
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Anchorage Alaska State Public Healt
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INDEX CASE INFORMATION Name: DOB: /
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CONTACT Name: Tuberculosis Contact
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Directly Observed Therapy (DOT) Cal
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B. Documents patient care activitie
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Alaska TB Program Section of Epidem
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Treatment Summary for Active TB Nam
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Interjurisdictional Tuberculosis No
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Latent Tuberculosis Infection (LTBI
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Alaska Tuberculosis Program 9210 Va
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Instructions for Collecting Sputum
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TB Case Management Information Requ
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Table 1: First-line anti-tuberculos
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Return the fax to the Drug Room (90
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Stock Orders: A small supply of
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TB/LTBI Medication Return Form Reas
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TB/LTBI Stock Medication Request FA
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TB Medication Dose Monitoring Regim
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TB Medication Dose Monitoring Regim
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ALASKA DEPARTMENT OF HEALTH AND SOC
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Tuberculosis Discharge Planning Che
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PART 2: 8. Have you ever been told
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Tuberculosis Treatment Contract Dep
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Statutes and Regulations Contents I
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Regulations Infection Control 7 AAC
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place of work is remote from patien
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(2) the child or a person acting on
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Glossary acid-fast bacilli (AFB): M
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eaction size on a later test, which
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disseminated TB: See miliary TB. dr
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immunocompromised and immunosuppres
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include medical history and TB symp
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thousands to millions of copies of
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secondary (TB) case: A new case of
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eproducing TB organisms from respir
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Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska

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